My ongoing therapy dilemma

[Daniel E.]

He is also on Youtube, e.g.:

An Introductory Overview of the Four Steps Treatment Method for OCD - YouTube

more videos:
Video - JEFFREY M. SCHWARTZ, M.D.


From the related thread at Psychlinks that David just mentioned:

The Four Steps - Dr Jeffrey Schwartz - Brain Lock

Four Steps Summary

Step 1: Relabel. Recognise that the intrusive obsessive thoughts and urges are the RESULT OF OCD.
Step 2: Reattribute. Realise that the intensity and intrusiveness of the thought or urge is CAUSED BY OCD; it is probably related to a biochemical imbalance in the brain.
Step 3: Refocus. Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes: DO ANOTHER BEHAVIOUR.
Step 4: Revalue. Do not take the OCD thought at face value. It Is not significant in itself.

There was a self-help book by someone else titled "The Situation is Hopeless But Not Serious." The book was not on OCD, but I find it helps to think of repetitive thoughts that way -- they seem so dark and harrowing at times, and yet do not need to be taken seriously at all.

 

[David Baxter PhD]

Wow. Thanks, @Daniel. I didn't know that.

 

[Daniel E.]

I didn't know he had those videos either, until today

My favorite part is when he talks about how, over time, the OCD behavior gets involved with one's self-identity, as opposed to the ideal: "it's not me, it's my OCD."

 

[gooblax]

Thanks, I'll take a look after work today (not DURING work, as long as my brain stays on work topics).
If it resonates this time around (other times it hasn't, but this time I can sort of see how it might fit) maybe I'll bring it up next time with my therapist because last session we were discussing how my difficulty focusing and some of my repeat thoughts is unlikely to be ADHD (he brought ADHD into the discussion, I was like nah bro I think not, he was like yeah I probably agree... So why bring it up dude? ).

 

[Daniel E.]

International OCD Foundation | OCD and ADHD Dual Diagnosis Misdiagnosis and the Cognitive 'Cost' of Obsessions

Individuals with ADHD may exhibit inattention, lack of impulse control, and risky behaviors. OCD on the other hand. is characterized as an internalizing disorder, meaning individuals with OCD respond to anxiety producing environments by turning inward.

 

[gooblax]

I suspect my therapist is just one of those people who find it easier to think via talking, rather than thinking separately from talking (like my team in France noticed as a massive difference for us in a ratio of 3:2 people).
So he probably just brought it up because it came to mind (rather than it being something he'd put any previous thought into) and we hadn't previously discussed focus/concentration. If I'd known we were going to discuss it then I'd have planned a better description of what's going on for me (and it didn't help that we kept dropping the video link because of the internet)... So this might help clarify for next session.

 

[David Baxter PhD]

Another way of looking at OCD:

 

[Daniel E.]

And from a psychodynamic therapist, Barry Brody:

I think early in our lives, we all learn about nothing. Most of us learn to fear it, then forget about it and spend the rest of our lives trying to avoid it. The most common methods of avoiding the experience of nothing are compulsions, addictions and obsessions. It is usually from behind peoples' compulsions, addictions and obsessions that we get a glimpse of this fear of nothing. Perhaps this is why we hang on so tenaciously to these behaviors--something is better than nothing. These behaviors seem to serve as a distraction from the experience of nothing and also serve as a desperate attempt to fill us up with something--love, sex, drugs, relationships, money, power.

However, lurking behind these behaviors that drive and control us is the ever-present specter of nothing. Like Chuckie in the horror movies, no matter how much success, love or money we acquire, it is never enough. It is never enough to put nothing to rest. And so it becomes a vicious cycle.

Of course there is an alternative...We can find another way to tolerate nothing and end the vicious cycle.

Something is Better Than Nothing

 

[David Baxter PhD]

Frankly, like many psychodynamic theories and therapies, that all seems a little nebulous and contrived to me.

From my observations, I think it is all about fear of uncertainty and lack of control. I don’t think it’s about nothingness and emptiness at all.

 

[Daniel E.]

BTW: Terror management theory: Offensive defensiveness

 

[H011yHawkJ311yBean]

Huh, I might ask my psychiatrist how I might tell if I was slightly OCD or just plain ol ADHD. Because it’s common to have comorbidity with ADHD and some of this sounds like me...


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[gooblax]

I'm still not sure if it fits.

I can see how the recurring nature of the set of thoughts could be construed as an obsessive thought, and ruminating on it and reading various articles (including ones that I've read multiple times) to try and understand what could be going on or to reassure myself that there's explanations of why I might think about some of this stuff seemingly all the time (and wasting more time in the process) could be mental compulsions.

But I made the mistake of looking into how one would do ERP for 'pure O' OCD and saw the advice that "do the opposite of what your OCD wants you to do" = "do something that will make you feel worse"... Which in my case seems that it would be to agree with my thoughts, and trying that just for a brief moment led to feeling sad. If it was an OCD thing, would that not normally result in anxiety rather than sadness?

Edit: Plus honestly the typical examples of obsessions sound like they'd be a lot more 'distressing' than whatever my thing is.

 

[David Baxter PhD]

ERP has more to do with compulsions than obsessions per se. That's why I recommended Brain Lock. Different approach.

 

[gooblax]

Yeah I think the Brain Lock approach would be better. I got hung up on the label of OCD (like if I'm not convinced I meet the criteria for OCD then I can't apply the wording of the approach directly)... But I suppose I do attribute part of my 'thing' to an anxiety/misfiring-brain response even if it's not full OCD, so I could still apply the approach in principle.

 

[Daniel E.]

The 4 steps is basically a form of mindfulness.

You Are Not Your Brain: The 4-Step Solution for Changing Bad Habits, Ending Unhealthy Thinking, and Taki ng Control of Your Life eBook: MD, Jeffrey Schwartz: Amazon.com.au: Kindle Store

The key to making life changes that you want--to make your brain work for you--is to consciously choose to "starve" these circuits of focused attention, thereby decreasing their influence and strength.

Schwartz and Gladding carefully outline their program, showing readers how to identify negative brain impulses, channel them through the power of focused attention, and ultimately lead more fulfilling and empowered lives.

International OCD Foundation | Mindfulness and Cognitive Behavioral Therapy for OCD

In ERP, you are being asked to confront your triggers and resist responding to them with compulsions. In mindfulness, you are being asked to simply remain aware when you are triggered, to accept the discomfort it causes, and to resist trying to change it with compulsions.

So it would work for a lot of things in addition to anxiety and OCD such as depression, anger, etc.

 

[Daniel E.]

But I made the mistake of looking into how one would do ERP for 'pure O' OCD and saw the advice that "do the opposite of what your OCD wants you to do" = "do something that will make you feel worse"...

A side note:
One way of doing ERP for Pure O may be recording the thoughts into a sound file (or writing them down) and then replaying/rereading them. Going over them may help just by becoming bored of them and getting the "surprise" factor out of the way (as in "the best defense is a good offense").

This method of recording is discussed in Grayson's book: Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty, Updated Edition: Grayson, Jonathan: 9780425273890: Amazon.com: Books

But I find physical exercise can help more than anything else at times.

Which in my case seems that it would be to agree with my thoughts, and trying that just for a brief moment led to feeling sad. If it was an OCD thing, would that not normally result in anxiety rather than sadness?

I had the same finding doing ERP for existential OCD.

OCD is often about what you care about the most, albeit a non-productive way of coping.

 

[David Baxter PhD]

There is more about the Brain Lock approach in this thread: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

I never used ERP at all with "Pure O" OCD. I think for many people it was counterproductive. So was thought-stopping. All they did was create even more anxiety and give the OCD thoughts even more power.

Brain Lock is really more about accepting the thoughts as part of your brain "misfiring" but learning how to not give it undue power. Sort of like "there's that thought again - it's just a thought, nothing more - let it go through me and past me - acknowledge it as a thought, an inaccurate or irrational thought - watch it coming like you were watching a train and don't put a lot of effort into stopping it (that just gives it more power) , and let it go do past you just like a train going on it's merry way down the tracks.

 

[Daniel E.]

Pure O Aint So Pure - OCD Therapy - Jayme Valdez, LMHC

All people with “Pure O” experience compulsions. Once many of my clients become aware of their compulsive behaviors, they are often surprised by how much more frequently the compulsive behaviors are happening than the actual intrusive thought! Examples of compulsive behaviors in “Pure O” include asking other for reassurance (that your relationship is okay, that your partner has not cheated, that you are not gay or a pedophile, etc), mentally reviewing memories or behaviors to make sure you didn’t harm someone, reciting prayers in your head compulsively, adding up numbers or arranging images/letters in your head until they “feel right.”

 

[David Baxter PhD]

Pure O Aint So Pure - OCD Therapy - Jayme Valdez, LMHC

All people with “Pure O” experience compulsions. Once many of my clients become aware of their compulsive behaviors, they are often surprised by how much more frequently the compulsive behaviors are happening than the actual intrusive thought! Examples of compulsive behaviors in “Pure O” include asking other for reassurance (that your relationship is okay, that your partner has not cheated, that you are not gay or a pedophile, etc), mentally reviewing memories or behaviors to make sure you didn’t harm someone, reciting prayers in your head compulsively, adding up numbers or arranging images/letters in your head until they “feel right.”

"Pure O" refers more to the fact that the symptoms/issues are thought-based rather than physical compulsive acts. Yes it is part of the OCD spectrum but it still differs in important ways from the more "compulsive" type.

 

[gooblax]

I'm just fed up with things, whatever the label. 14 years of various levels of **** and to what end? At the moment it just seems pointless. I can't even solve my stupid work task which is probably actually easy. Even if therapy ends up helping in the long run, which I can't imagine it will, who cares because I'm not even a useful real person anyway. :facepalm: